324 Assistive Technology Services | HCBS-5300-MANUAL

This chapter establishes the requirements for assistive technology services to individuals in their place of residence funded in whole or in part with non-Medicaid federal and state funds managed by the Area Agency on Aging (AAA), and any associated matching funds. These requirements may act as guidelines for a fee-for-service model.

Under the Assistive Technology Act of 1998 (ATA), the Governor of a state shall designate a public agency as a lead agency for implementing assistive technology services. Georgia’s public agency is Tools for Life (TFL), a program of the Georgia Institute of Technology, College of Design, Center for Inclusive Design, and Innovation (formerly AMAC Accessibility).

According to the Assistive Technology Act (ATA), the purpose of an assistive technology (AT) program is:

AAAs should provide assistive technology services to secure and maintain maximum independence and dignity in a home environment for older individuals and persons with disabilities who are capable of self-care with appropriate supportive services.

The Division of Aging Services (DAS) is not the State’s lead agency; however, DAS supports the Assistive Technology Act by providing the following services:

DAS encourages AAAs to follow these ATA service definitions in establishing the scope of their assistive technology program. AAA may contract, partner, and/or establish referral mechanisms with qualified individuals or agencies to fulfill specific service activities.

The ATA identifies core principles that AAAs should follow in administering AT services and in serving older adults and persons with disabilities.

In serving clients AAAs should demonstrate:

In administering AT services, AAAs should:

DAS requires that assistive technology services be delivered in a person-centered manner. Program staff should approach individuals and families with empathy and an understanding of their life experiences and challenges by searching for and acting upon what is important to that individual, including their wants, needs, and values.

DAS strongly encourages collaboration between the AAAs and the Centers for Independent Living (CIL) to facilitate access to information, resources, and education about assistive technology.

Assistive technology services target persons who have a physical or mental disability or disorder that restricts his/her ability to perform basic activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs), or that threatens his/her capacity to live independently, and their caregivers. (See MAN 5300, CH 316 for additional priorities for caregiver services)

AAAs should follow additional criteria specific to fund sources. If funding is not sufficient to serve all eligible consumers requesting services, the Older Americans Act and Client Prioritization guidelines, found in MAN 5300, CH 118 provides for giving preference to specific persons:

Individuals must have an impairment(s) and/or unmet need(s), as indicated by his/her DON- R score. AAAs should prioritize individuals who have impairment and/or unmet need in any of the domains with scores of 2 or greater.

AAAs will not provide assistive technology services in a nursing home, personal care home, or other setting where the provision of this service is included in the cost of care.

An efficient service delivery system is characterized by person-centered approaches and cost-effective outcomes for both consumers and the community. Therefore, DAS supports the implementation of a conflict-free service delivery system.

MAN 5300, 202 Program Guidelines and Requirements includes the key elements included in the design of such a system.

Assistive technology activities must be planned with input from the client, whenever possible, caregiver or a representative, based on an assessment of their needs and the degree of physical and/or cognitive impairment of the care receiver.

Assessment/evaluation fees is an allowable service activity in the provision of assistive technology services.

An optimal assistive technology program requires staff who have specialized skills and competencies to provide the following core functions:

AAA staff shall screen individuals including identifying problems that he/she experiences in daily life and that he/she hopes are eliminated or diminished as a result by AT services.

AAA staff shall discuss with potential clients how AT can address their level of impairment, unmet need, or both. The AAA staff will initiate service delivery, refer clients to provider organizations or other resources (i.e.: Tools for Life), or place them on a waiting list for services. AAA staff shall assist in the selection, acquisition, and proper usage of identified assistive technology devices.

For information regarding screening through Aging & Disability Resource Connection, see MAN 5200, 5025 Service Availability and Access. The AAAs will maintain and manage waiting lists for the services, as necessary. See Manual 5200, 5038 Waiting List Management and Criteria for Admission to Services.

Not every applicant will request, require, or benefit from Assistive Technology services. Each AAA will clearly identify in its Area Plan how services will be coordinated and how resources will be allocated and managed to optimize the effectiveness and efficiency of Assistive Technology services.

Refer to MAN 5300, 114 Guidelines for Client Assessment

DAS requires that staff use the DON-R to determine an individual’s need and potential benefit for assistive technology. Assistive technology may reduce an individual’s level of impairment and/or their unmet need for care. The preferred method of assessment for assistive technology services is via home visit.

Staff should also assess the degree to which the individual can properly use assistive technology devices based on physical disability, cognitive impairment, or behavioral health condition. This may require referrals to experts in assessing an individual’s ability to benefit from assistive technology (ex: occupational therapy, Tools for Life, etc.).

The AAA may provide device demonstrations to determine the degree to which individuals can use or may benefit from AT. AAAs are to follow their device loan program procedures and guidelines to assist individuals in proper usage of devices (or durable medical equipment) before purchasing devices.

Staff should follow up with each individual 60 days after receiving AT devices to determine whether assistive technology devices are being used properly, whether the devices are reducing level of impairment and/or reducing unmet need for care, and whether the assistive devices are impacting the individual’s quality of life.

For assessments of caregivers and to use assistive technology to reduce caregiver burden, refer to MAN 5300, Chapter 316 – Caregiver Services.

The ATA states that the term “capacity building and advocacy activities” mean efforts that:

To support these advocacy efforts, each AAA should include information about assistive technology in its outreach and community education, for example:

At a minimum, each AAA must provide AT device demonstrations twice a year through community outreach events.

AAA staff should practice diligence to promote the safety and well-being of individuals to whom the AAA provides assistive technology, including:

The primary goal of assistive technology services is to aid older adults, persons with disabilities, and their caregivers to achieve maximum self-sufficiency and enhance their quality of life.

AAAs must choose at least one outcome measure for their AT program:

Outcome #1: Reduce caregiver burden by providing assistive technology

Indicators:

Outcome #2: Increase independence for individuals by providing assistive technology

Indicators:

Outcome #3: Increase opportunities for individuals to participate in meaningful activities providing assistive technology

Indicators:

DAS does not require that a AAA achieve every outcome and/or indicator for the delivery of assistive technology services to be deemed effective.

The AAA should ensure that each client record contains emergency contact information (name and telephone number(s) at a minimum).

It is the explicit intent of DAS to serve clients in greatest need and to maximize the efficiency and effectiveness of the Aging Network.

DAS anticipates that during the span of service delivery to a consumer, the consumer’s needs, supports, and resources will change. Based upon the ongoing process of assessment and reassessment, the AAA may determine that the individual is receiving maximum benefit from assistive technology and initiate discharge according to DAS policy (see MAN 5300, 202 Program Guidelines and Requirements).

When a device such as walkers, canes, wheelchairs, or other durable medical equipment is no longer useful/needed, the AAAs are to follow their own procedures and guidelines to provide the individuals the option to return the item for another agency or individual to re-use (device can be recycled, reused).

Staff must include proper documentation in the DDS system that includes the reason for discharge and whether the device was collected, and/or re-utilized.

AAAs and provider agencies will assure that all consumers, or their caregivers, receive a written copy of their rights and responsibilities as program/service participants upon their admission to services. See MAN 5300 Appendix E for the suggested “Client’s Rights and Responsibilities”.

AAAs will establish written client complaint procedures for use by each provider. Procedures should include the minimum requirements outlined in MAN 5300, 202 Program Guidelines and Requirements. In addition, the complaint procedures must include:

AAAs will establish written appeals procedures for use by each provider and are consistent with MAN 5300, 110 Grievance Procedures for Individuals in Non-Medicaid HCBS Programs.

General staffing information is described in MAN 5300, 202 Program Guidelines and Requirements.

Staff providing assistive technology services must view the following 3 introductory training videos (link provided below):

gatfl.gatech.edu/New Staff Training Videos

Staff must conduct a site visit with an existing assistive technology program within the first 3 months of employment.

Additionally, it is recommended but not required staff should view the Sharpening Your Skills: Exploring Assistive Technology Toolkits PowerPoint presentation found on the Tools for Life website, under the TFL WIKI tab.

AAAs must assure that providers employing persons having direct contact as primary, secondary or alternative job duties conduct a criminal records investigation, according to state law and current policy of the Department of Human Services in MAN 5600, 3036 Criminal History Investigations.

Businesses, agencies and individuals providing assistive technology services shall practice sound and effective fiscal planning and management, financial and administrative record keeping and reporting.

General information about data collection and reporting are described in CH 202. The AAA may require additional information systems at its discretion but may not fail to meet the minimal standards required by DAS. The AAA must retain relevant information not captured in the DAS data system in paper files according to DAS program policies.

Specific programmatic/service requirements for collection and/or reporting of data include:

The AAA staff will use data from the DAS data system, at a minimum, to facilitate quality improvement and data analysis.

Providers must establish and implement written policies and procedures for the maintenance and security of client records, specifying who will supervise the maintenance of records, which will have custody of records, to whom records may be released, and for what purposes in compliance with MAN 5600, 3012 Area Agency on Aging Records.

Each client record must include the following information about assistive technology devices\services in the manner that DAS requires:

Each AAA/provider is encouraged to offer in-home services as a fee-for-service enterprise to enhance the sustainability of the Aging network. In doing, the AAA must follow all requirements of the Older Americans Act and MAN 5600, Sections 2025-2028, “Fee for Service System”, “Cost Share”, “Voluntary Contribution”, and “Private Pay Services”.

Assistive technology services provided to consumers as a fee-for-service should not differ in quality from service provided to consumers funded through public funds.

Refer to MAN 5300, 202 Program Guidelines and Requirements

Refer to MAN 5300, 202 Program Guidelines and Requirements

Refer to MAN 5300, 202 Program Guidelines and Requirements

Assistive Technology Act of 1998

Older Americans Act Of 1965: 2020 Reauthorization

DAS Manual 5200, Section 5025 - Service Availability and Access

DAS Manual 5200, Section 5038 - Waiting List Management

DAS Manual 5300, Section 114 - Guidelines for Client Assessment

DAS Manual 5300, Section 118 - Prioritizing Clients

DAS Manual 5300, Section 202 - Program Guidelines and Requirements

DAS Manual 5600, Section 316 - Caregiver Services

Tools for Life

Tools for Life New Staff Training Videos